Magnitude of PTSD Related to Sexual Violence in Conflict Settings and Effectiveness of Psychological Interventions in Armed Conflict Contexts: A Systematic Review and Meta-Analysis
Background: Sexual violence in conflict settings is a major determinant of psychological morbidity, particularly post-traumatic stress disorder (PTSD). While several reviews have addressed trauma in displaced populations, few have provided consolidated estimates specific to survivors in sub-Saharan Africa. Methods: We conducted a systematic review and meta-analysis of observational and quasi-experimental studies published between 2002 and 2024. Methodological quality was assessed using the Joanna Briggs Institute tool; only studies scoring ≥50% were included. Data were extracted into Excel and analyzed in Stata 16 using random-effects models. Subgroup analyses were performed by age, setting, measurement tool, and time since assault. Heterogeneity was assessed with I2 and Cochran’s Q, and publication bias with funnel plots and Egger’s test. Results: Fifty-eight studies (≈32,000 survivors) were included, of which 42 contributed quantitative data. The pooled prevalence of PTSD was 48% (95% CI: 42% - 54%), with higher rates among adolescents (55%, 95% CI: 47% - 62%) compared to adults (44%, 95% CI: 38% - 50%). Community-based studies reported greater prevalence (52%) than clinical settings (46%). Key associated factors included social stigma (OR = 2.1, 95% CI: 1.6 - 2.7), lack of social support (OR = 1.9, 95% CI: 1.4 - 2.5), delayed access to care >72 h (OR = 1.8, 95% CI: 1.3 - 2.4), multiple exposures to violence (OR = 2.6, 95% CI: 2.0 - 3.4), and forced displacement (OR = 1.7, 95% CI: 1.2 - 2.3). Overall heterogeneity was moderate to high (I2 = 68%), with evidence of slight publication bias (Egger’s p = 0.04). Conclusions: Nearly one in two survivors of sexual violence in conflict settings develops PTSD, with adolescents and community-based populations particularly vulnerable. Effectiveness of psychotherapeutic interventions varies: gold-standard therapies (CBT, EMDR, NET) achieve 60% - 80% improvement, while community approaches show more modest but socially acceptable effects. These findings underscore the urgent need for systematic screening, culturally adapted interventions, and sustained follow-up strategies to reduce the psychological burden and foster resilience in conflict-affected communities.
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